臺灣博碩士論文加值系統

目的：顳顎關節骨性關節炎(Temporomandibular joint osteoarthritis, TMJOA)發生率及其症狀帶來的痛苦和困擾在口腔顎顏面區已是一個影響非常大的問題。此研究的目的是要探討以3mm厚度的中心關係咬合板(centric relation occlusal splint, CROS)合併液態濃縮生長因子(liquid phase concentrated growth factors, LPCGF)注射治療顳顎關節骨性關節炎(osteoarthritis, OA)病人的臨床發現。
材料與方法：此回溯性世代研究的研究族群是從2014年04月至2016年03月到作者門診接受治療的顳顎關節骨性關節炎(Temporomandibular joint osteoarthritis, TMJOA)病人。預測變項(predicted variable)是治療方法。結果變項(outcome variables)包括有關節聲響(joint sound)、下顎骨歪斜(deviation of the mandible, DoM)、因顳顎關節異常導致的頭痛(headache attributed to TMD)、肌筋膜疼痛伴隨牽引痛(myofascial pain with referral)、關節疼痛評估指數(arthralgia visual analog scale, VAS)及最大輔助張口度(maximal assisted opening, MAO)。以中心關係咬合板治療的階段，所有變項的評估對象都是以人為單位，並於治療前及治療後每1個月回診時做記錄；注射液態濃縮生長因子的階段，結果變項中除了關節聲響(joint sound)的評估是以關節為單位外，其他的變項依然是以人為單位，並於治療前及治療後1週及每1個月至第4個月回診時做記錄。比較治療前後差異時，若遇類別變項(Categorical variables)則採用McNemar χ2 test，遇連續變項(Continuous variables)則用配對t檢定(paired t test)。比較時間趨勢(trends)間的改變量用多迴歸(multiple regression)做分析。比較關節聲響(joint sound)的發生率(incidence)時用比例檢定(proportional test)來做分析。
結果：29位病人中，男性6位(20.68%)，女性23位(79.31%)。年齡分布自15至84歲(mean age 39.55±15.49 years)。經過中心關係咬合板治療的平均時間為345.0±161.3天(min:8.0, max:722.0, median:309.0)。以中心關係咬合板(centric relation occlusal splint, CROS)治療後，除關節聲響(joint sound)沒有達到顯著的改善外(p>0.05)，其他症狀如下顎骨歪斜(deviation of the mandible, DoM) (p<0.05)、因顳顎關節異常導致的頭痛(headache attributed to TMD) (p<0.05)、肌筋膜疼痛伴隨牽引痛(myofascial pain with referral) (p<0.05)、關節疼痛評估指數(arthralgia visual analog scale, VAS) (p<0.001)及最大輔助張口度(maximal assisted opening, MAO) (p<0.001)都有達到統計上顯著的改善。以中心關係咬合板(centric relation occlusal splint, CROS)治療後再注射一次2ml液態濃縮生長因子(liquid phase concentrated growth factors, LPCGF)，下顎骨歪斜(deviation of the mandible， DoM)、因顳顎關節異常導致的頭痛(headache attributed to TMD)、肌筋膜疼痛伴隨牽引痛(myofascial pain with referral)、關節疼痛評估指數(arthralgia visual analog scale, VAS)及最大輔助張口度(maximal assisted opening, MAO)都有維持住以中心關係咬合板(centric relation occlusal splint, CROS)治療的效果達4個月(即沒有再退步也沒有再進步)。注射後平均12.06±8.54天後有23個關節聲響(joint sound)症狀得到解除(p<0.001)。注射後平均 48.5±64.1天後有26個關節聲響(joint sound)症狀得到解除(p<0.001)。
結論：3mm厚度的中心關係咬合板(centric relation occlusal splint, CROS)就可以治癒除關節聲響(joint sound)之外的顳顎關節骨性關節炎(osteoarthritis, OA)臨床症狀。注射2ml液態濃縮生長因子(liquid phase concentrated growth factors, LPCGF)一次，平均12天就可以治癒63.9%的關節聲響(joint sound)。未來尚需與其他治療方法的成效做比較。

目錄

英文縮寫--------------------------------------------II

摘要--------------------------------------------------III-V

壹、導論----------------------------------------------p-1

貳、研究構想----------------------------------------p-5

叁、研究材料與方法-------------------------------p-6

肆、研究結果----------------------------------------p-12

伍、討論----------------------------------------------p-16

陸、參考資料----------------------------------------p-28

柒、表格----------------------------------------------p-34

捌、圖-------------------------------------------------p-40
 

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